S0448 Characterizing Regurgitation and Heartburn Symptoms in Patients Undergoing High Resolution Esophageal Manometry With Esophageal pH-Impedance Monitoring

Abstract

INTRODUCTION: Studies that characterize GERD often fail to describe regurgitation as well as they do heartburn. The study aims to: 1) describe the frequency and severity of heartburn and regurgitation in patients referred for esophageal function evaluation; 2) describe the esophageal disorders with these symptoms; and 3) investigate the pathophysiology of these symptoms. METHODS: We retrospectively reviewed data from patients undergoing High Resolution Esophageal Manometry with Impedance (HREMI) and Esophageal pH Impedance monitoring (EpHI) between December 2019 and March 2020. Patients filled out the Reflux Disease Questionnaire (RDQ) and the Patient Assessment of Upper GI symptoms (PAGI-SYM). The RDQ evaluates both severity and frequency of heartburn, regurgitation, and dyspeptic symptoms. Mean symptom severity was calculated as (symptom frequency [days per week] x symptom intensity)/7 (scoring is from 0 to 3). RESULTS: Of the 171 patients (average age 55 ± 15 years; 69% female), 164 completed HREMI (7 were unable to tolerate procedure) and 108 completed EpHI. 74 were determined to have GERD by esophageal acid exposure time and/or impedance episodes. Regurgitation movement (RDQ score 0.8; present in 52%) and regurgitation taste (RDQ score 0.6; present in 48.5%) was more prevalent than substernal burning (RDQ score 0.5, present in 35.1%) and substernal pain (RDQ score 0.5, present in 35.1%). Regurgitation taste correlated with regurgitation movement (r = 0.50, P < 0.001), substernal burning (r = 0.53, P < 0.001), and substernal pain (r = 0.39, P < 0.001). Acid exposure time correlated with substernal burning (r = 0.22, P = 0.029) and dyspepsia burning (r = 0.26, P = 0.010). The presence/absence of a hiatal hernia (HH) did not affect regurgitation symptoms. Patients with GERD had similar LES pressures (P = 0.09), hiatal hernia sizes (P = 0.07), and RDQ symptoms. Regurgitation was present in 47% of patients with ineffective esophageal motility, 20% with absent contractility, 33% achalasia, and 39% with no abnormalities (P = 0.21). CONCLUSION: Regurgitation is correlated with heartburn and dyspepsia. It is a common symptom of patients undergoing HREMI and EpHI and is present in many disorders. Additionally, increasing acid exposure was related to substernal burning and dyspepsia burning but was not correlated to regurgitation.(image 3) These results suggest that although acid suppression therapy may be helpful for heartburn, it may not be helpful for treating regurgitation.Table 1Table 2Figure 1